WHAT:
The Subcommittee on Health, chaired by Rep. Michael C. Burgess, M.D. (R-TX), held a hearing reviewing five bipartisan bills to improve health care.
WHY:
“While these bills cover different topics within health care, there is one common thread that connects them. All of the bills and discussion drafts before us today aim to improve the access to and quality of health care for American patients and their families," said #SubHealth Chairman Burgess.
WHO:
* Hugh Chancy, Member, Board of Directors, National Community Pharmacist’s Association (Opening Statement )
* Curtis Cunningham, Vice President, National Association of States United for Aging and Disabilities (Opening Statement )
* Rick Merrill, President and CEO, Cook Children’s Health Care System (Opening Statement )
* Matt Salo, Executive Director, National Association of Medicaid Directors (Opening Statement )
* The Honorable Derek Schmidt, Attorney General, State of Kansas (Opening Statement )
* David Yoder, Executive Director of Member Care and Benefits, Blue Cross Blue Shield Association’s Federal Employee Plan (Opening Statement )
KEY MOMENTS:
“My first experience with so called gag clauses occurred in 2015 when one of my pharmacies in a rural city in southern Georgia served several patients on the city’s employer-sponsored insurance, including the city’s mayor," stated Mr. Chancy. “The city had just changed insurance providers and many of my patients experienced a rise in their prescription co-payments. Specifically, the mayor’s copayment for one medication went from roughly $7 to $26. When I noticed this difference, I informed the mayor that it would be cheaper if he paid for his prescription off his insurance. The mayor was fortunate to have the political wherewithal to contact the right people in charge of the city’s insurance plan to complain about the change changes and the oddity that paying for the prescription off insurance was a better deal. It goes without saying that other patients do not have similar avenues to voice their concerns about their prescription drug coverage."
Mr. Chancy continued, “What happened next has become a common story. After the mayor contacted the plan, the plan consulted with their PBM [Pharmacy Benefit Manager] who then issued a verbal warning to my pharmacy for talking to patients about their drug costs. The PBM stated we were in violation of our contract for disparaging the plan when we discussed the cost of a drug off insurance. We were told that if our pharmacy were to do so again, there would be consequences, including exclusion from PBM networks."
Speaking in support of H.R. 3891, Kansas Attorney General Derek Schmidt testified, “This bill proposes to allow states the option of expanding their MFCU’s [Medicaid Fraud Control Units] scope to combat Medicaid beneficiary-patient abuse wherever it may occur, including in non-institutional settings. That state-by-state option, which mirrors the flexibility in current law that allows states to opt-in to using MFCUs to combat patient abuse in board-and-care facilities, is an important component of the bill. That is optional authority that, if H.R. 3891 is enacted, Kansas intends to exercise."
In an exchange with Rep. Tim Walberg (R-MI), Attorney General Schmidt shared the story about a patient who died during a house fire, an incident that could have probably been prevented had a care attendant been present. Attorney General Schmidt noted that unfortunately under current law, MFCUs are currently unable to prosecute the care attendant for such negligent care. However, he noted that H.R. 3891 would remedy this problem. Watch the clip here.
RESOURCES:
The Majority Memorandum, witness testimony, and an archived webcast are available online HERE.
